U.S. Eleventh Circuit Court of Appeals Looks At Limits of Personal Injury Protection Benefits Under Florida’s No-Fault Motor Vehicle Law

Under Florida law, automobile insurers have provided benefits of up to $10,000 for losses sustained due to bodily injury, sickness, disease, or death from the use, ownership, or maintenance of a motor vehicle for several decades. Amendments were made to these benefits in 2012. One subsection requires that the reimbursement for anything up to $10,000 be made only after a physician, dentist, physicians’ assistant, or advanced registered nurse has determined that the injured person had an emergency medical condition as defined by the statute. The other subsection limits the reimbursement to $2,500 if there was a determination that the injured person did not have an emergency medical condition.

The statute (Fla. Stat. Sec 627.736) is silent on what happens when no determination is made. The federal appellate court reviewed two appeals made by injured parties in Robbins vs. Garrison Property and Casualty Ins. Co. (No. 14-13725), who were insured by the same insurance company with policies governed by Florida law. In both cases, neither had a medical provider’s determination regarding whether or not the injured person suffered an emergency medical condition. The insurance company limited the payment to $2,500 for each party.

Each injured person appealed the insurance company’s determination, and they were met with orders of dismissal with the same conclusion. Without an emergency medical determination made under § 627.736(1)(a)(3), benefits are capped at $2,500. The federal Court of Appeals could not find any guidance in state case law, so it looked to the statute itself to determine what should happen in the absence of any determination. The appellate court disagreed with the assertions of the judges and the insurance company that the statute requires an injured person to take affirmative action to provide the insurance company with the determination of an emergency medical condition. The court looked to the statute as a whole and agreed with the injured parties that the sub-sections essentially cancel each other out.

The court then looked at the legislative intent behind the statute. The stated intent of the amendments made by the Florida legislature was to reduce the payment of fraudulent claims, which would then lower insurance premiums. After looking at legislative staff analyses, the intent became clear to the court that the $10,000 ceiling was only meant to be available to those with severe injuries. Otherwise, the PIP medical benefit was capped at $2,500. The Court of Appeals agreed with the lower courts’ decisions to limit the benefits to $2,500, and it affirmed the rulings to dismiss the suits.

When you are faced with mounting medical bills after an accident, you want to maximize the amount of funds available to you through all means available. The Florida car accident attorneys at Donaldson & Weston have the personal injury experience you need to negotiate with insurance companies or litigate your claim. For a free, confidential consultation, call our office at 772-266-5555 or 561-299-3999.